What My Degree Didn’t Teach Me About My First Job in a Psychiatric Care Unit!


By Tiffani Hughes

Several years ago, I received my B.S. in Psychology.  My mother was a counselor and as a kid, I used to read her psychology books and “diagnose” my friends and family.  After I arrived at university, and began attending classes, I heard jokes that most students take psychology to find out what was wrong with them!  I just loved it!  The idea of solving the complex problems of the human mind overwhelmed me with curiosity.

After graduation, I began working in the field within 2 months.  I worked at a community clinic and then moved to an acute psychiatric unit.  I quickly discovered that my education did little to prepare me for my actual jobs.  So, if you’re contemplating a degree in psychology, here are some of the things I learned on the job that aren’t really in the textbooks!

None of your patients want to be there.

Patients undergoing acute psychiatric care can be committed there involuntarily.  Involuntary status of a patient legally means that they were deemed “a threat to themselves or others.”  Furthermore, there are those identified as “elopement risks”.  They just don’t want to be there.  It is your job to keep them there.  Making them comfortable helps.

Nothing is safe.

When a patient is admitted, facilities search patient belongings for disallowed items.  Common contraband includes: belts, sharp objects, scissors; items with cords.  But occasionally, the patients get creative with unexpected items.  For example, once we were required to collect all the women’s bras on the unit containing underwire, as one patient had figured out its use capacity for self-harming.  Even hand sanitizer foams were once removed due to the alcohol content and a resourceful young alcoholic in detox!


There is no way around this.  Most hospitals do not use mechanical restraint, for the obvious reason that they are inhumane.  Unfortunately, this means that you are the restraint, while the nurses prepare a sedative (affectionately called “booty juice”), is a “therapeutic hold” –which roughly means trying to hold a patient still while trying not to injure you or him.  I’m 90 pounds soaking wet, trust me, excuses are futile.  When a patient insists on removing all their clothing and smearing fecal matter on the walls, you are expected to act!

Treat your patients like human beings

This part came relatively easily to me because I found no evidence indicating that mental illness was merely a disguise for alien life among us.  You will find most patients are regular people down on their emotional luck.  Talk to them.  All of them.  Let them know that they matter.

Psych work is an extremely rewarding career, but it can also be very stressful.  I could write volumes on “Things I Learned and Experienced” in this field–all with valuable lessons attached.  But I leave you with this: There is no such thing as “crazy or “sane”, it’s about helping people get “well”.

Tiffani Hughes is a writer/blogger with a B.S. in Mental Health and Human Services.  She lives in Orange, Texas, USA.

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